I. Background of the Research
Military service members and veterans may be exposed or suffer posttraumatic stress disorder (PTSD) due to severe combat-related traumatic stressors. Because of their exposure to an extreme trauma, they suffer from persistent re-experiences of the threatening or traumatic event, continual avoidance of associative stimuli for the trauma, unusual numbness for general sensitivity, and other symptoms of exaggerated arousals. Any direct personal contact, witness of an actual recurrence, or experience with seemingly similar events may pose a threat to their physical integrity. Victims of PTSD manifest disarrayed behavior, intense horror, fear, agitation, powerlessness, etc. because of triggering traumatic events. Symptomatic manifestation of PTSD associate both the aversive stimuli and the contextual cues with threats wherein ensuing disturbance is related to impairment of their previous normal functioning (e.g., lost of sense of self) (Donovan, 2010).
Some of the traumatic events experienced by military staff vary. The traumatic event that is processed by service personnel or veterans is dependent on their psychological makeup and traumatic experiences. Posttraumatic stress disorder recurs in many ways. Soldiers with intrusively recurrent recollections of traumatic events go through recurrent nightmares. They undergo dissociative conditioning in reliving psychologically painful events, which may last for a short while up to several days. Any resemblance of the traumatic event can trigger intense physiological reactivity (e.g., distress). Nonetheless, the stimuli that trigger the trauma can usually be avoided. Persons with PTSD can normally employ deliberate outmaneuvering efforts by means of avoiding conversations, thoughts, feelings, or traumatic events. They may avoid individuals, activities, and/or situations which only arouse recollections of past events through amnesia. Those who have PTSD can use decreased responsiveness to the immediate surrounding whenever they apply psychic numbing, emotional anesthesia, etc. as enduring defensive reorientation strategies.
Additional characteristic of PTSD symptoms include markedly dissociative behavior, unreasonable complaints to participate in an event they enjoy doing previously, diminished interest, emotional detachment and estrangement, and reduced affection, intimacy, tenderness, and sexuality. Further, service persons may develop foreshortened future (e.g., lack of affection to his/her spouse, kids, and career). Other persistent PTSD symptoms include increased anxiety, arousal, and so forth. Accompanying symptoms are difficulty falling asleep, immoderate wakefulness, and excessive startles. Other soldiers with PTSD show outburst of anger as well as persistent irritability and difficulty completing task.
II. History of PTSD in the Military
Posttraumatic stress disorders (PTSD), battle disorder, shell shock, or combat fatigue is believed to have existed since time immemorial. It is just a new name for an old mental disorder. Survival from fear is considered its key motivating defense. In the early 1800s, there was an initial discussion on trauma experienced by soldiers in the battlefield. Military doctors diagnosed soldiers as physically exhausted that need some rest. Within that century, the disorder was medicalized as symptomatic of abnormal heart palpitation, labored respiration (dyspnea), extreme fatigue, losing consciousness, tremors, startles, sweating, helplessness, etc. During wartimes (such as American Civil War, World Wars), soldiers who suffered PTSD were relatively higher. During those times, PTSD was a serious problems to military physicians because it was ambiguously hard to diagnose. It had crippling effect to the military force, aside from its enduring impact. This “trauma and stress-related disorder” was postulated to be psychological and neurological, but it did not stand medical scrutiny (American Psychiatric Association, 2013, p. 271). During World War 2, enlisting in the US army required psychiatric screening exam to prevent psychologically-unfit individuals from entering and not enduring wartime horrors. Soldiers were expected to be more manly and not suffer combat neurosis. Despite the effort, some soldiers still suffered the disorder.
Nowadays, there is a great deal of biomedical research on PTSD. Although increasingly medicalized, cultural expectations (such as male strength) among soldiers remained the same. Many service members suffered from PTSD. They show intense prompting and emotions (e.g., avoidance). Soldiers typically have amnesia and diminished responsiveness. They shut down their feelings, thoughts, and emotions on people, surroundings, and other events. In addition, military persons with PTSD have dim vision not to expect normal living, successful marriage, career, etc. In its entire history, PTSD victims were indeed seriously injured by it.
III. Causes of PTSD among Military Personnel
PTSD among military staff has been attributed to life-threatening experiences where people suffer from severe helplessness, intense fear, and/or other horrifying situations. However, medical researchers, doctors, and other health practitioners cannot pinpoint the exact cause why soldiers are more prone to acquire PTSD than others. PTSD can be a complex combination of inherited mental health risk, extent and severity of a traumatic experience, and/or abnormal brain functioning because of external stressors. In many cases, military personnel who are more at risk of acquiring PTSD are of Hispanic ethnic origin, people who suffer extensive period of trauma, individuals with early childhood traumas, and persons who lack emotional support from family members and friends (Schnurr, Lunney, & Sengupta, 2004). Likewise, people with high level of depression and anxiety, individuals with relatives who have history of mental ill health, and people who experienced traumatic brain injury are also prone to this disorder. In addition to the several causes just mentioned, medical researchers have found out that certain neurochemicals give false alarm, which can be switched off with medication to prevent PTSD from occurring. More promising treatments will help further medical practitioners to detect early and prevent the occurrence of this type of mental disorder.
IV. PTSD in the Military
PTSD is often evident among military service persons and veterans. Although some wars (e.g., Persian Gulf War) were short-lived and had less traumatic impact than others, many soldiers and war veterans also suffered from substance abuse. High rates of alcohol abuse among veterans, for example, were associated with their response to the symptoms of the disorder while in military service. Other than chronic PTSD and drug related problems, some service members had developed persistent sexual problems during such wars as Operation Iraqi Freedom, Operation Enduring Freedom, Vietnam War.
Despite many returning veterans’ exhibition of the several symptoms of PTSD, it is important that military personnel should seek treatment even when they suffer social stigma (Fenton, 2013). Professional help and assistance are available from primary and healthcare providers depending on PTSD victims’ specific needs.
V. Treatment and Prevention of PTSD in the Military
Since posttraumatic stress disorder (PTSD) among military personnel has many potential causes, use of multiple treatments require medical practitioners to be extra wary concerning patients’ informed consent, proper care, treatment option, extent of support, and advantages and disadvantages. Practitioners have to familiarize themselves about research and clinical data for the development of individualized rationale for treatment approach for particular clients. The rationale should serve as a basis for PTSD treatment.
Research results revealed that a part of the brain is responsible for regulating fear. Practitioners should be competent enough in diagnosing other PTSD-related conditions. They should ensure that their capacity for legally making diagnosis and treatment for specific conditions are client-specific. Further, practitioners should have background in mental health to assist military personnel to work through traumas and its symptoms prior to any treatment. Health practitioners well-trained in neurofeedbacking are also successful in minimizing the anxiety and depression of PTSD victims. PTSD patients have abnormally high level of hormones and hyper-vigilant nervous system responsible for the reliving of traumas. Biofeedback, e.g., relaxation training, is an alternative treatment for PTSD patients. They are taught how to relax using positive intervention in combination with other techniques (e.g., guided imagery). A recreated worldview helps PTSD sufferers to get rid of disruptions and incapacity.
Among military personnel, chemoprophylaxis and pharmacotherapy have been used in the prevention of development of this type of mental disorder. Drugs, such as morphine, cortisol, and propanolol are used to prevent PTSD while soldiers are in the battlefield. During the Iraqi war, for instance, combatants were given high dosage of morphine were there is lesser likelihood of PTSD from developing. However, there is a need for more empirical study about this drug’s protective effect. Likewise, war soldiers who experienced severe battle stress were administered with cortisol for PTSD prevention. On the other hand, propanol, a beta blocker, has demonstrated the reduction of sleep disturbances and other hyperarousal symptoms such as startle, numbing, hypervigilance, and re-experiencing . Despite assessment of ongoing efforts in PTSD prevention and treatment, further empirical studies are necessary to find the “most effective treatment modalities” (Kim, 2013).
VI. Conclusion
A number of research findings revealed that posttraumatic stress disorder (PTSD) is a prevalent among military service members and veterans. The history of the disorder dates as far as human desires for protection, safety, and power. It is caused by a variety of factors during wartime events. Initially evident during wartimes, soldiers with PTSD suffer from war stress, fatigue, fear, helplessness, and other violence. In case a service member or veteran has already known history of family-related mental ill-health, high level of anxiety, brain injury, and other leading causes, he/she is at a greater risk of experiencing disorder. Some of the prevention and/or treatments for PTSD include pharmacotherapy, chemoprophylaxis, psychiatric counseling, religious therapy sessions, emotional support from family and friends, to name a few. To date, further empirical research on PTSD is necessary to prevent long-term recurrence or permanent treatment of the individual’s disorder.
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Virginia: American Psychiatric Publishing.
Donovan, E. (2010). Propranolol Use in the Prevention and Treatment of Posttraumatic Stress Disorder in Military Veterans: Forgetting Therapy Revisited. Perspectives in Biology and Medicine, 53(1), 61-74. doi:10.1353/pbm.0.0140
Fenton, D. (2013, August 5). Stigma of mental health disorders in the military remains: Veterans with PTSD falling through the cracks might not be the ones you’d expect. Retrieved from Ottawa Citizen: http://www.ottawacitizen.com/health/Stigma+mental+health+disorders+military+remains/8750501/story.html
Kim, S. (2013, May 1). Meta-Analysis of Psychotherapy and Alternative Treatments for Combat-Related PTSD. Retrieved from Baylor University Waco: Honors College Theses: https://beardocs.baylor.edu:8443/xmlui/handle/2104/8662
National Defense Authorization Act, Public Law 112–81 (United States' Supreme Court December 31, 2011).
Schnurr, P., Lunney, C., & Sengupta, A. (2004). Risk factors for the development versus maintenance of posttraumatic stress disorder. Journal of Trauma Stress, 17(2), 85–95.
